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Wiki source code of IRS FORM 1094-C

Last modified by Andrew K on 2025/12/31 20:51
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1 == FORM 1094-C ==
2
3 ===== //Click on the individual boxes below for specific IRS Instructions
4 \\[[image:attach:1.png]]// =====
5
6 ===== =====
7
8 |**Part I: Applicable Large Employer Member (ALE Member)**
9 |(((
10 |[[Line 1, Name of ALE Member (Employer)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e630]]
11 |[[Line 2, Employer Identification Number (EIN)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e635]]
12 |[[Lines 3-6, Employer's Complete Address>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e646]]
13 |[[Lines 7 and 8, Contact Person's Name and Telephone Number>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e651]]
14 |[[Line 9, Name of Designated Government Entity (DGE)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e668]]
15 |[[Line 10, Employer Identification Number (EIN) of Designated Government Entity (DGE)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e673]]
16
17 |[[Lines 11-14, Designated Government Entity's (DGE) Complete Address>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e684]]
18 |[[Lines 15 and 16, Contact Person's Name and Telephone Number>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e689]]
19 |[[Line 17, Line reserved for future use>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e694]]
20 |[[Line 18, Total number of Forms 1094-C submitted with this transmittal>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e699]]
21 |[[Line 19, Authoritative Transmittal>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e704]]
22 )))
23
24 |**Part II: ALE Member Information**
25 |[[Line 20, Total Number of Forms filed by and/or on behalf of the employer.>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e722]]
26 |[[Line 21, ALE Member is part of Aggregated ALE Group>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e727]]
27 |[[Line 22, Certifications of Eligibility>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e741]]
28
29 [[image:attach:2.png]]
30
31
32 |**Part III: ALE Member Information — Monthly (Lines 23–35)**
33 |[[Column (a), Minimum Essential Coverage>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e883]]
34 |[[Column (b), Full-Time Employee Count for ALE Member>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e966]]
35 |[[Column (c), Total Employee Count for ALE Member>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e980]]
36 |[[Column (d), Aggregated Group Indicator>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e988]]
37 |[[Column (e), Aggregated Group Indicator>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e996]]
38
39 [[image:attach:3.png]]
40
41
42 |**Part IV: Other ALE Members of Aggregated ALE Group**
43 |[[Lines 36-65, Other ALE Members of Aggregated ALE Group>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e1001]]
44
45 ----
46
47 == Related Pages: ==
48
49
50 === [[IRS Forms 1095-B>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1095-B.WebHome]] ===
51
52 ====== Learn more about the IRS Form 1095-B. ======
53
54
55 === [[IRS Forms 1094-B>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1094-B.WebHome]] ===
56
57 ====== Learn more about the IRS Form 1094-B. ======
58
59
60 === [[IRS Forms 1095-C>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1095-C.WebHome]] ===
61
62 ====== Learn more about the IRS Form 1095-C. ======